Session Name: Poster Session A: Kidney Antibody Mediated Rejection
Session Type: Poster Session
Date: Saturday, May 2, 2015
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
The long-term prognosis of kidney transplants may be impacted by delayed diagnosis of rejection. Guidelines suggest that recipients with an increase of serum creatinine (Scr) ≥25% should be biopsied. ANIDAR is a prospective, multicenter observational study that aims at Assessing a Non-Invasive assay to Diagnose Allograft Rejection in patients with a rise in Scr that falls below this threshold. Here we report the clinical results of the first 37 subjects recruited out of a target of 150.
Incident recipients >3mo post-transplant were biopsied if they had an increase ≥20% in Scr in the last 3 months, but were not ordered a clinically indicated biopsy. The biopsy results showed rejection in 18 (49%) subjects with the following diagnoses: borderline changes (BL, n=6, 33%), acute TCMR (n=3, 17%), chronic-active TCMR (n=1, 6%) and chronic ABMR (n=8, 44%, including 3 C4d negative cases). Pathology in non-rejectors were mostly minor inflammation/tubulitis (n=4), chronic changes (n=4), normal biopsy (n=3), BK nephropathy (n=2) and recurrent GN (n=2). There were no differences between non-rejectors and rejectors for Scr at biopsy (1.7±0.7 vs. 1.6±0.4mg/dl), percent increase in Scr from baseline (23±7 vs. 23±3%) and urinary protein/creatinine ratio (0.4±0.8 vs. 0.5±0.6mg/mmol). There was a trend toward lower number of immunosuppressive agents in rejectors (2.4±0.8 vs. 2.8±0.4, p=0.10). Interestingly, Scr in chronic ABMR was lower than in TCMR and BL grouped together (1.4±0.3 vs. 1.8±0.3mg/dl; p=0.039).
These preliminary data show that a high proportion of patients with a ≥20% and <25% increase in Scr of unknown clinical relevance had biopsy-proven rejection. Whether these patients would have presented with a rise in Scr at a later time, or persisted with ongoing inflammation in the absence of a significant rise in Scr is unknown. There is no signal that rejectors could be differentiated from non-rejectors based on routine clinical lab data. Mechanistic studies are underway to characterize the immunological profile of these patients and determine the utility of a non-invasive assay based on ex vivo cell culture and urinary chemokines.
To cite this abstract in AMA style:Serres SDe, Ho J, Cailhier J-F, Cardinal H, Désy O, Vallin P, Béland S, Côté I, Houde I, Noël R, Lapointe I, Agharazii M. High Prevalence of Allograft Rejection in Kidney Recipients With a Mild Increase in Serum Creatinine: Interim Report of the ANIDAR Study [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/high-prevalence-of-allograft-rejection-in-kidney-recipients-with-a-mild-increase-in-serum-creatinine-interim-report-of-the-anidar-study/. Accessed September 21, 2023.
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